Dean Celia

News Connection

Navigating the Inflation Reduction Act's Impact on Drug Pricing and Health Care

05/29/2024

Dean Celia

During a recent webinar hosted by the Drug Channels Institute, Adam Fein, PhD, discussed the specifics of the Inflation Reduction Act (IRA) and its potential impacts and timeline. First Report Managed Care connected with other managed care...

During a recent webinar hosted...

05/29/2024

First Report Managed Care

News

Analysis Shows Proposed CMS ‘Best Price’ Rule May Increase Rebate Liability, Impacting Medicaid

04/26/2024

Dean Celia

A proposed rule from Centers for Medicare & Medicaid Services (CMS), “Misclassification of Drugs, Program Administration and Program Integrity Updates Under the Medicaid Drug Rebate Program,” has been in the spotlight recently. Major health...

A proposed rule from Centers for...

04/26/2024

First Report Managed Care

News

Increased Scrutiny of Prior Authorization: Are Payers Fully to Blame, and Can AI Improve the Process?

04/05/2024

Dean Celia

The increased scrutiny of prior authorization, highlighted by media reports and government actions, prompts debate over payer responsibility while exploring the potential for AI to enhance the process.

The increased scrutiny of prior...

04/05/2024

First Report Managed Care

News

Who Will Benefit Under the Medicare Part D Out-of-Pocket Spending Cap?

02/27/2024

Dean Celia

Starting in 2024, Medicare Part D enrollees could benefit from a cap placed on out-of-pocket drug spending, thanks to a provision in the Inflation Reduction Act of 2022 (IRA).

Starting in 2024, Medicare Part...

02/27/2024

First Report Managed Care

News

Alternative Funding Programs: A Tempting Choice Laden With Risks

02/26/2024

Dean Celia

The escalating concern over specialty drug costs for employers and health plan executives is driven by significant spending increases, reaching $315 billion in 2022, with specialty drugs comprising 50% of total spending despite their low...

The escalating concern over...

02/26/2024

First Report Managed Care

News

Latest Formulary Exclusions from Top PBMs Demonstrate Issues in the Drug Pricing Landscape

02/21/2024

Dean Celia

Experts highlight the impact of the "warped incentives" in drug pricing's gross-to-net bubble, revealing that despite significant discounts, certain biosimilars are excluded from the formularies of major pharmacy benefit managers, leading to...

Experts highlight the impact of...

02/21/2024

First Report Managed Care

News

Assessing the 2024 Medicare Fee Changes: Impact on Physicians, Payers, and Value-Based Care

02/20/2024

Dean Celia

The 2024 Medicare physician fee schedule final rule, after evaluation using the fee schedule look-up tool and input from 2 experts, presents a mixed picture for primary care physicians (PCPs) and potential improvements for specialists, though...

The 2024 Medicare physician fee...

02/20/2024

First Report Managed Care

News

What Do the Drug Price Changes Announced in January Tell Us?

02/14/2024

Dean Celia

The initial findings regarding the changes in prescription drug prices for 2024 have arrived. In this summary, we’ll outline shifts and seek insights from Edmund J Pezalla, MD, founder and CEO, Enlightenment Bioconsult, examine underlying...

The initial findings regarding...

02/14/2024

First Report Managed Care

Cover Story

Analyzing Policies Designed to Control Specialty Drug Costs

06/20/2023

Dean Celia

ICER’s new white paper addresses white bagging, brown bagging, and site of service policies and offers best practice recommendations. Our panel examines the issue and explains which suggestions will work best.

ICER’s new white paper addresses...

06/20/2023

First Report Managed Care

Cover Story

Health Trends to Track in 2023

04/13/2023

Dean Celia

As a potential recession looms on the heels of the pandemic, it is challenging to predict where the US health care system is headed in 2023. Still, we asked our experts to analyze emerging trends, read the tea leaves, and explain how events...

As a potential recession looms...

04/13/2023

First Report Managed Care